Validity and Responsiveness of the Generic Health-Related Quality of Life Instrument (VetMetrica™) in Cats With Osteoarthritis. Comparison of Vet and Owner Impressions of Quality of Life Impact.

Validity is not an inherent property of a measurement scale and so evidence for validity relating to its use for particular purposes, with defined populations and in specified contexts must be accumulated. We have published the development of a web-based, generic health-related quality of life instrument (VetMetrica™) to measure the affective impact of chronic disease in cats and provided evidence for its validity in a mixed population of cats, some of which, according to veterinary judgement, were healthy and others of which were suffering from chronic conditions likely to affect their quality of life, often with multiple co-morbidities present. The first aim of the current study was to demonstrate the construct validity of the VetMetrica™ generic instrument when used with cats suffering from osteoarthritis, by testing the hypothesis that the health-related quality of life profile of cats with different severities of osteoarthritis would differ and by demonstrating convergent validity between the health-related quality of life profile scores and independently quantified vet-assessed pain and quality of life impact scores. The latter involved simple correlation analysis and investigation of the relationship between health-related quality of life domain scores and vet-assessed scores, when adjusted for other potential explanatory variables including number of comorbidities and age. Responsiveness-the ability to detect clinically relevant change-is an essential quality for an evaluative instrument and it also provides evidence for "longitudinal validity". Therefore, a second aim of this study was to demonstrate that changes in health-related quality of life domain scores concurred with the clinician's impression of change over time in the health status of cats with osteoarthritis, thus providing evidence for the instrument's responsiveness. Previously, we have reported disagreement between owner and vet impression as to health status in cats in general, but not in relation to any specific disease. Accordingly, the third study aim was to investigate the extent of agreement or disagreement between owner impression of the impact of osteoarthritis on their cats' quality of life and vet impression of such impact. Fifty one percentage of cat owners believed their cats to be perfectly healthy despite a clinician diagnosis of osteoarthritis.

Effect of Age, Breed, and Sex on the Health-Related Quality of Life of Owner Assessed Healthy Dogs.

Using an app, this exploratory study generated information on HRQL in a large cohort of dogs deemed healthy according to the owner. It forms the basis for further studies investigating the natural history of HRQL of dogs to inform the interpretation of interventional studies, but highlights the risks of relying on owner impression of health status. A previously published health-related quality of life (HRQL) instrument (VetMetrica™) that generates scores in four domains of quality of life in dogs - Energetic and Enthusiastic (E/E), Happy and Content (H/C), Active and Comfortable (A/C), and Calm and Relaxed (C/R), generated information on HRQL in 4,217 dogs (3 months-21 years). Dogs were categorized by age; young, 3-47 months, middle-aged, 48-95 months, and old, 96 months and older. Owners considered 2,959 dogs (3-95 months) to be "in perfect health" and these were used to explore the relationship between age, sex, breed and HRQL in apparently healthy dogs. Mean score was significantly greater (better) in young compared to middle-aged dogs in E/E, H/C and A/C and declined with advancing age. In H/C there was a small but significant difference in mean score between female and male dogs (mean greater in females), with a similar rate of decline in each gender with advancing age. In E/E there were very small but statistically significant differences in mean scores between certain breeds. In A/C there was a statistically significant interaction between breed and age and the rate of decline with advancing age differed with breed. Overall, age, breed, and sex predicted very little of the variation seen in HRQL scores. Data from a subset of 152 dogs, for whom clinical information was available, were used to examine the agreement between clinical evidence and owner opinion. According to the clinical records, 89 dogs were healthy and 63 had evidence of chronic disease. There was an approximately 40% disagreement between owner opinion on health status and clinical evidence of chronic disease (35% disagreement in all dogs and 43% in old dogs). HRQL scores were generally higher in dogs for whom there was no evidence of disease in the clinical record.

"It's Embedded in What We Do for Every Child": A Qualitative Exploration of Early Childhood Educators' Perspectives on Supporting Children's Social and Emotional Learning.

Early childhood educators play an important role in supporting children's social and emotional development. While a growing body of research has examined the impact of curriculum-based social and emotional learning (SEL) programs on child outcomes, the approaches educators use to strengthen children's social and emotional functioning through their everyday practices are less defined. This study explored Australian early childhood educators' perspectives on children's social and emotional development, the approaches educators use to encourage children's social and emotional skills, the enablers and barriers to SEL within the preschool environment, and the additional support needed. Thirty Early Childhood Education and Care professionals participated in semi-structured interviews and focus group discussions. Findings suggest children's social-emotional development is at the forefront of educator planning, practice, and reflection. Participants described utilising various approaches to support children's social and emotional skills, embedded within interactions and relationships with children and families. Specifically, strategies could be grouped into four broad categories: a nurturing and responsive educator-child relationship; supporting SEL through everyday interactions and practice; utilising the physical environment to encourage SEL; and working in partnership with caregivers. There was, however, inconsistency in the variety and type of approaches identified. Time constraints, group size, educator confidence and capability, high staff turnover, and limited guidance regarding high-quality social and emotional pedagogy were identified as key barriers. Participants sought practical strategies that could be embedded into daily practice to build upon current knowledge.

Rationale, Design and Methods Protocol for Participatory Design of an Online Tool to Support Industry Service Provision Regarding Digital Technology Use 'with, by and for' Young Children.

Adults who educate and care for young children are exposed to mixed-messages about what is in the best interests of young children in digital society. Such mixed-messaging makes adult decision-making about technology use in the best interests of young children hard to achieve. This project addresses this problem by working with leading organisations providing services related to quality digital media production, online-safety education, digital play and digital parenting. Using a Participatory Design approach, families, educators, industry partners and researchers will conduct mixed-methods investigations concerning: Relationships; Health and Well-being; Citizenship; and Play and Pedagogy to identify practices concerning technology use 'with, by and for' young children. Iterative design cycles will develop an Online Tool to support organisations providing services to young children and the adults responsible for their education and care. As society becomes more digital families and educators need new knowledge about what people do in digital society to inform their decision-making. This project will support organisations to use an empirically informed approach to service provision regarding using technologies in the best interests of young children.

Do Curriculum-Based Social and Emotional Learning Programs in Early Childhood Education and Care Strengthen Teacher Outcomes? A Systematic Literature Review.

There is growing awareness of the benefits of curriculum-based social and emotional learning (SEL) programs in Early Childhood Education and Care settings for children's social, emotional, and cognitive development. While many SEL programs aim to strengthen teachers' capacity and capability to foster children's social and emotional skills, research effort has focused on understanding the impact on child outcomes, with less emphasis on improvement in teaching quality. This systematic literature review examined the effectiveness of universal curriculum-based SEL programs on teacher outcomes. Fifteen studies met inclusion criteria, capturing ten distinct SEL interventions. The findings suggest SEL programs may strengthen teaching quality, particularly the provision of responsive and nurturing teacher-child interactions and effective classroom management. Data were insufficient to ascertain whether participation improved teachers' knowledge, self-efficacy, or social-emotional wellbeing. The potential pathways between SEL intervention, teaching quality and children's developmental outcomes are discussed.

Integrating Health and Educational Perspectives to Promote Preschoolers' Social and Emotional Learning: Development of a Multi-Faceted Program Using an Intervention Mapping Approach.

High-quality early childhood education and care (ECEC) can strengthen the social and emotional skills that are crucial for children's ongoing development. With research highlighting an increasing prevalence of emotional and behavioural challenges in young children, there is emphasis on embedding teaching practices and pedagogies to support social and emotional skills within early learning programs. A growing body of research has examined the impact of social and emotional learning programs in ECEC; however, few studies describe the intervention development process, or how educators and other professionals were engaged to increase the relevance and feasibility of the program. The current paper describes the development of the Cheshire Social-Emotional Engagement and Development (SEED) Educational Program, an online learning tool to support early childhood educators to foster children's positive mental health. Cheshire SEED was designed using five steps of the Intervention Mapping methodology: (i) comprehensive needs assessment to create a logic model of the problem; (ii) creation of program outcomes and change objectives mapped against determinants of educator behaviour; (iii) co-design of theory-based methods and practical strategies; (iv) program development; and (v) adoption and implementation planning. The process and decisions at each step of the IM protocol are presented, and the strengths and limitations of the approach to develop a mental health intervention for ECEC settings are discussed.

Development, initial validation and reliability testing of a web-based, generic feline health-related quality-of-life instrument.

OBJECTIVES: The objective of this study was to develop a valid, reliable, web-based generic feline health-related quality-of-life (HRQoL) questionnaire instrument to measure the affective impact of chronic disease. METHODS: A large initial item pool, obtained through interviews with cat owners, was reduced using predetermined criteria, survey scores for relevance and clarity, and the ability of individual items to discriminate between healthy and sick cats when owners completed a prototype questionnaire. Using these data, factor analysis was used to derive a scoring algorithm and provide evidence for factorial validity. Validity was demonstrated further in a field trial using a 'known groups' approach (sick vs healthy cats will have a different HRQoL profile, and the HRQoL profile of cats will deteriorate as comorbidities increase). Test-retest reliability was assessed using intra-class correlation coefficients (ICCs). RESULTS: In total, 165 items were reduced to 20 and, on the basis of a factor analysis that explained 72.3% of the variation in scores input by 71 owners of 30 healthy and 41 sick cats using the prototype, these were allocated to three domains (vitality, comfort and emotional wellbeing [EWB]) with a scoring algorithm derived using item loadings. Subsequently, the owners of 36 healthy and 58 sick cats completed one or two (n = 48) assessments. Median scores (healthy vs sick) for all domains were significantly different ( P <0.001), 78% of cats were correctly classified as healthy or sick and for comorbidities the correlation coefficients were moderate (vitality 0.64; comfort 0.63; EWB 0.50). Test-retest reliability was good (ICC vitality 0.635; comfort 0.716; EWB 0.853). CONCLUSIONS AND RELEVANCE: This study provides initial evidence for the validity and reliability of a novel HRQoL instrument to aid the assessment and management of chronic diseases of cats.

Using Intervention Mapping for child development and wellbeing programs in early childhood education and care settings.

Supporting children's social and emotional learning benefits all elements of children's development and has been associated with positive mental health and wellbeing, development of values and life skills. However, literature relating to the creation of interventions designed for use within the early childhood education and care settings to support children's social and emotional skills and learning is lacking. Intervention Mapping (IM) is a systematic intervention development framework, utilising principles centred on participatory co-design methods, multiple theoretical approaches and existing literature to enable effective decision-making during the development process. Early childhood pedagogical programs are also shaped by these principles; however, educators tend to draw on implicit knowledge when working with families. IM offers this sector the opportunity to formally incorporate theoretical, evidence-based research into the development of early childhood education and care social and emotional interventions. Emerging literature indicates IM is useful for designing health and wellbeing interventions for children within early childhood education and care settings. Considering the similar underlying principles of IM, existing applications within early childhood education and care and development of interventions beyond health behaviour change, it is recommended IM be utilised to design early childhood education and care interventions focusing on supporting children's social and emotional development.

When is the right time?

Veterinary medicine is veering further towards prolongation of life at all costs, without the safeguard of being able to robustly measure quality of life. Jacky Reid, Andrea Nolan and Marian Scott discuss major steps forward in the ability to measure changes in health-related quality of life.

Social and Emotional Learning Associated With Universal Curriculum-Based Interventions in Early Childhood Education and Care Centers: A Systematic Review and Meta-analysis.

Importance: Social-emotional competence in early childhood influences long-term mental health and well-being. Interest in the potential to improve child health and educational outcomes through social and emotional learning (SEL) programs in early childhood education and care (ECEC) settings is increasing. Objective: To conduct a systematic review and meta-analysis of studies examining the social, emotional, and early learning outcomes associated with universal curriculum-based SEL programs delivered to children aged 2 to 6 years in center-based ECEC settings. Data Sources: Keyword searches of Education Resources Information Center (ERIC), MEDLINE Complete, PsycINFO, and Proquest Dissertations and Theses Global databases were conducted to identify all relevant studies published from January 1, 1995, through December 31, 2017. Study Selection: Studies included in this review examined universal curriculum-based SEL intervention delivered to children aged 2 to 6 years in a center-based ECEC setting. All assessed individual-level social and/or emotional skill after the SEL intervention and used an experimental or quasi-experimental design (ie, studies that did not or were not able to randomly allocate participants to intervention and control groups) with a control group. Data Extraction and Synthesis: A total of 13 035 records were screened, of which 362 were identified for full-text review. A systematic literature review was conducted on 79 studies. Multilevel random-effects meta-analyses were conducted on 63 eligible studies from October 2 through 18, 2018. Main Outcomes and Measures: Social competence, emotional competence, behavioral self-regulation, behavior and emotional challenges, and early learning outcomes. Results: This review identified 79 unique experimental or quasi-experimental studies evaluating the effect of SEL interventions on preschooler outcomes, including a total of 18 292 unique participants. Sixty-three studies were included in this meta-analysis. Compared with control participants, children in intervention conditions showed significant improvement in social competence (Cohen d [SE], 0.30; [0.06]; 95% CI, 0.18-0.42; P < .001), emotional competence (Cohen d [SE], 0.54 [0.16]; 95% CI, 0.22-0.86; P < .001), behavioral self-regulation (Cohen d [SE], 0.28 [0.09]; 95% CI, 0.11-0.46; P < .001), and early learning skills (Cohen d [SE], 0.18 [0.08]; 95% CI, 0.02-0.33; P = .03) and reduced behavioral and emotional challenges (Cohen d [SE], 0.19 [0.04]; 95% CI, 0.11-0.28; P < .001). Several variables appeared to moderate program outcomes, including intervention leader, type of assessment, informant, child age, and study quality. Conclusions and Relevance: According to results of this study, social and emotional learning programs appeared to deliver at a relatively low intensity may be an effective way to increase social competence, emotional competence, behavioral self-regulation, and early learning outcomes and reduce behavioral and emotional difficulties in children aged 2 to 6 years. Social and emotional learning programs appear to be particularly successful at increasing emotional knowledge, understanding, and regulation.

Co-induction of cyclooxygenase-2 [correction of cyclooxyenase-2] and early growth response gene (Egr-1) in spinal cord in a clinical model of persistent inflammation and hyperalgesia.

BACKGROUND: This study characterised the effects of persistent peripheral inflammation of the foot on pain and spinal cord expression of cyclooxygenase-1 and -2 (COX-1 and COX-2) and early growth response gene 1 (Egr-1), known markers of neuronal plasticity, in a clinical model of naturally-occurring inflammatory disease and hyperalgesia in sheep ('footrot'), before and after routine treatment (parenteral treatment with antibiotics and antiseptic footbathing). The temporal pattern of expression of COX-1, COX-2 and Egr-1 mRNA and protein were analysed using real-time PCR and Western blotting. RESULTS: Animals affected with persistent peripheral inflammation displayed significant hyperalgesia and lameness (a proxy indicator of spontaneous pain) restricted to the inflamed limb. Hyperalgesia and lameness were significantly attenuated 1 day after treatment, and resolved further by day 7 and day 3, respectively. COX-2 but not COX-1, protein expression was up-regulated in spinal cord from lame animals on day 0, before treatment. Following treatment and attenuation of pain behaviours, levels of COX-2 returned to control levels. Significant induction of Egr-1 mRNA and protein were observed in spinal cord from lame animals. Three days after treatment, levels of Egr-1 mRNA returned to control levels, however, Egr-1 protein remained elevated. CONCLUSION: Elevated levels of spinal COX-2 and Egr-1 protein correlate with the presence of pain and hyperalgesia, and may underlie persistent pain, although a direct causal link has still to be established. Understanding the temporal pattern of expression of key mediators in clinical pain states may lead to better strategies to manage pain.

The impact of prenatal stress on basal nociception and evoked responses to tail-docking and inflammatory challenge in juvenile pigs.

The consequences of tail-docking (at 2-4 days) and prenatal stress (maternal social stress during the 2nd third of pregnancy) on baseline nociceptive thresholds and responses to acute inflammatory challenge were investigated in juvenile pigs in two studies. Nociceptive thresholds were assessed on the tail root and on the hind foot using noxious mechanical and cold stimulation before and after acute inflammatory challenge by intradermal injection of 30 µg capsaicin (study 1) or 3% carrageenan (study 2) into the tail root. Four groups of 8 (study 1, n=14-16 pigs/treatment) or 5 (study 2, n=6 pigs/treatment/sex) week-old pigs were exposed to the main factors: maternal stress and treatment (docked vs. intact tails). In study 1, tail docking did not significantly alter thresholds to noxious mechanical stimulation, whilst prenatally stressed pigs had significantly higher baseline thresholds to noxious mechanical stimulation on the tail root and on the hind foot than unstressed pigs, whether tail-docked or intact. Capsaicin injection induced localised mechanical allodynia around the tail root in all treatment groups, but had no effect on noxious plantar mechanical responses; however prenatally stressed offspring exhibited significantly attenuated response thresholds to capsaicin compared to controls. In study 2 tail docking did not alter thresholds to either mechanical or noxious cold stimulation. Baseline response durations to noxious cold stimulation of the tail root were significantly shorter in both sexes of prenatally stressed pigs, whilst male but not female prenatally stressed pigs exhibited significantly higher baseline thresholds to mechanical stimulation than controls, although results in female pigs tended towards significance. Carrageenan injection into the tail root induced localised mechanical and cold allodynia in all treatment groups, effects that were attenuated in prenatally stressed pigs. Collectively, these findings indicate that prenatal stress can induce long-term alterations in nociceptive responses, manifest as a reduced sensitivity to noxious mechanical and cold stimulation and evoked inflammatory allodynia. Neonatal tail-docking does not lead to long-term alterations in nociception in pigs.

Activation of metabotropic glutamate receptor 7 in spinal cord inhibits pain and hyperalgesia in a novel formalin model in sheep.

This study set out to characterize the contribution of group III metabotropic glutamate receptor 7 activation to nociceptive behaviour and mechanical hypersensitivity in a novel formalin test in sheep. The mGlu receptor 7 allosteric agonist, N,N'-dibenzhydrylethane-1,2-diamine dihydrochloride (AMN082; 2-20 mM), the nonselective group III mGlu receptor agonist L-(+)-2-amino-4-phosphonobutyric acid (0.2-20 mM) and drug vehicle were injected intrathecally into naive subjects (n=7 per group), or 5 min preformalin (3%; 0.2 ml)/saline injection (intradermal), into the lower forelimb of adult female sheep (n=5-7 per group). Forelimb withdrawal thresholds to noxious mechanical stimulation and pain behaviours (time spent nonweight bearing or flinching) were assessed for up to 180 min. Formalin induced a characteristic biphasic pain-behaviour response and mechanical hyperalgesia between 1-5 and 30-120 min postinjection. Treatment with AMN082, but not L-(+)-2-amino-4-phosphonobutyric acid significantly inhibited both early and late phase formalin-induced hyperalgesia and pain behaviours. AMN082 also induced a rapid but short lasting analgesia in naive subjects. These data suggest that enhancing endogenous metabotropic glutamate receptor 7 activity in spinal cord, using the novel allosteric modulator, AMN082, blocks pain and hyperalgesia, and may be of therapeutic benefit for the treatment of inflammatory pain.

The selective metabotropic glutamate receptor 7 allosteric agonist AMN082 inhibits inflammatory pain-induced and incision-induced hypersensitivity in rat.

This study characterized the contribution of metabotropic glutamate receptor 7 (mGlu7 receptor) activation to the development of inflammatory hyperalgesia and allodynia, using a novel, systemically active mGlu7 receptor allosteric agonist, N, N'-dibenzhydrylethane-1,2-diamine dihydrochloride (AMN082). The effects of AMN082 (0.1, 1 or 5 mg/kg, intraperitoneally; 5 or 50 nmol, intrathecally) or diclofenac (5 mg/kg, intraperitoneally) administered 30 min preprocedure or 3 h postprocedure on hindpaw withdrawal latency (in seconds) to thermal stimulation, and response threshold (in grams) to mechanical stimulation, were measured in adult rats (n = 6-8 per group) before and up to 24 h after intradermal injection of carrageenan into the hindpaw or hindpaw incision. Precarrageenan injection of 1 and 5 mg/kg AMN082, but not diclofenac inhibited thermal hyperalgesia, whereas postcarrageenan, both AMN082 and diclofenac attenuated thermal hyperalgesia and allodynia. In the paw incision model, presurgical and postsurgical administration of 1 and 5 mg/kg AMN082 inhibited thermal hyperalgesia, but not allodynia, whereas diclofenac was effective in attenuating both thermal hyperalgesia and allodynia but only when administered postsurgically. Intrathecal injection of AMN082 postcarrageenan and postsurgery also significantly attenuated thermal hyperalgesia. Enhancing endogenous mGlu7 receptor activity inhibits postinjury stimulus-evoked hypersensitivity and may be of therapeutic benefit for the treatment of inflammatory and incision-induced pain.

Development of a mechanical stimulator and force measurement system for the assessment of nociceptive thresholds in pigs.

A mechanical stimulator and force measurement system was developed to quantify withdrawal thresholds to noxious mechanical stimulation of the foot in young pigs. The device and associated PC software have design and control features not previously used in other mechanical stimulators. The device, capable of delivering stimulus rates between 2 and 17 mm/s, maximum force 27 N, was validated in a cross-over study on 8 juvenile pigs (6-8 weeks of age) to check the repeatability and reliability of force threshold measurement and assess its ability to measure changes in force threshold following an inflammatory challenge. Threshold force measurements were obtained over several time periods before and after the pigs received a 0.25 ml subcutaneous injection of 3% carrageenan in 0.01 M phosphate buffered saline (PBS) or PBS in the hind foot. Consistent withdrawal thresholds were measured in injected (ipsilateral) and contralateral feet, 24 h and 30 min prior to injection (mean 8.4; 95% CI 7.1-9.7 N). Carrageenan injection, but not PBS injection, induced a significant decrease in withdrawal thresholds 90 min after injection (4.6+/-0.9 N) which remained reduced for 6h after injection. The testing system provided reliable and reproducible measurements of foot withdrawal thresholds to noxious mechanical force in young pigs (weight range 32-39 kg), and was capable of detecting and monitoring changes in threshold sensitivity following the induction of acute local inflammation in the foot. The system is suitable for studying nociceptive mechanisms in pigs.

Pre-natal stress amplifies the immediate behavioural responses to acute pain in piglets.

Pre-natal stress (PNS) or undernutrition can have numerous effects on an individual's biology throughout their lifetime. Some of these effects may be adaptive by allowing individuals to tailor their phenotype to environmental conditions. Here we investigated, in the domestic pig Sus scrofa, whether one possible consequence of a predicted adverse environment could be altered pain perception. The behavioural response of piglets to the surgical amputation ('docking') of their tail or a sham procedure was measured for 1 min in piglets born to mothers who either experienced mid-gestation social stress or were left undisturbed throughout pregnancy. A behavioural pain score was found to predict the docked status of piglets with high discriminant accuracy. Piglets exposed to PNS had a significantly higher pain score than controls, and for each litter of tail-docked piglets, the average pain score was correlated with mid-gestation maternal cortisol levels. The data presented here provide evidence that the experience of stress in utero can result in a heightened acute response to injury in early life. Speculatively, this may represent an adaptive alteration occurring as a consequence of a pre-natal 'early warning' of environmental adversity.

The effects of an area-based intervention on the uptake of maternal and child health assessments in Australia: a community trial.

BACKGROUND: Recognition of the importance of the early years in determining health and educational attainment and promotion of the World Health Organization Health for All (HFA) principles has led to an international trend towards community-based initiatives to improve developmental outcomes among socio-economically disadvantaged children. In this study we examine whether, Best Start, an Australian area-based initiative to improve child health was effective in improving access to Maternal and Child Health (MCH) services. METHODS: The study compares access to information, parental confidence and annual 3.5 year Ages and Stages visiting rates before (2001/02) and after (2004/05) the introduction of Best Start. Access to information and parental confidence were measured in surveys of parents with 3 year old children. There were 1666 surveys in the first wave and 1838 surveys in the second wave. The analysis of visiting rates for the 3.5 year Ages and Stages visit included all eligible Victorian children. Best Start sites included 1,739 eligible children in 2001/02 and 1437 eligible children in 2004/05. The comparable figures in the rest of the state were and 45, 497 and 45, 953 respectively. RESULTS: There was a significant increase in attendance at the 3.5 year Ages and Stages visit in 2004/05 compared to 2001/02 in all areas. However the increase in attendance was significantly greater at Best Start sites than the rest of the state. Access to information and parental confidence improved over the course of the intervention in Best Start sites with MCH projects compared to other Best Start sites. CONCLUSION: These results suggest that community-based initiatives in disadvantaged areas may improve parents' access to child health information, improve their confidence and increase MCH service use. These outcomes suggest such programmes could potentially contribute to strategies to reduce child health inequalities.

The effect of an area-based intervention on breastfeeding rates in Victoria, Australia.

OBJECTIVES: Best Start is an area-based early childhood intervention where projects are developed and implemented through a community partnership. A core tenet of the initiative is that implementing projects through a partnership generates greater value than would be expected if projects were undertaken independently by partner members. In this study we examine whether: (1) Best Start is effective in increasing the proportion of infants being fully breastfed at 3 months and 6 months. (2) The quality of community partnerships is a potential mechanism for change. METHODS: Best Start was implemented in Victoria, Australia. The study examined breastfeeding rates before and after Best Start in sites with Best Start breastfeeding projects compared to the rest of state. The relationship between partnership quality scores and breastfeeding percentages was also examined. Both analyses controlled for socioeconomic and demographic differences and clustering by area. RESULTS: Best Start targeted some of the most socially disadvantaged communities in Victoria. In the 3 years of its operation, the rates of fully breastfeeding at 3 months (OR 1.30, 95% CI 1.14-1.47) and 6 months (OR 1.33, 95% CI 1.1-1.61) increased in Best Start sites compared to the rest of the state. Quality of partnership scores was positively associated with increased percentages of fully breastfeeding (3 months=OR 1.03, 95% CI 1.01-1.06; 6 months=OR 1.03, 95% CI 0.98-1.08). CONCLUSIONS: These results suggest that area-based interventions are effective in increasing percentages of fully breastfeeding. The study also supported the idea that developing quality community partnerships had a positive influence on their success.

Blockade of metabotropic glutamate receptor 5 activation inhibits mechanical hypersensitivity following abdominal surgery.

This study used the metabotropic glutamate 5 (mGlu5) receptor subtype-selective antagonist 2-methyl-6-(phenylethynyl)pyridine (MPEP) to characterise the contribution of mGlu5 receptor activity to pain and hypersensitivity in an animal model of post-surgical pain. Adult female Wistar rats (200-250g) were anaesthetised with isoflurane (2%) and underwent a midline laparotomy with gentle manipulation of the viscera, and the effects of pre- (30min) or post- (5h) operative treatment with MPEP (1, 3 or 10mgkg(-1); i.p.) or drug-vehicle on hindpaw withdrawal latency (in seconds) to thermal stimulation (Hargreave's Test) and response threshold (in grams) to mechanical stimulation (using a dynamic plantar aesthesiometer) were measured. Animals that underwent surgery displayed significant hypersensitivity to mechanical stimulation of the hindpaws. Hypersensitivity was maximum at 6h post-surgery (44.5+/-2.4% decrease; p<0.01 vs. anaesthesia only controls) and persisted for 48h. Surgery had no effect on thermal withdrawal latency. Both pre-operative and post-operative administration of 10mgkg(-1)MPEP blocked mechanical hypersensitivity induced by surgery (p<0.01 vs. vehicle treatment). MPEP had no effect on acute nociceptive thresholds in naïve animals. These data suggest that activity at mGlu5 receptors contributes to development of pain and hypersensitivity following surgery.